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Appointment of Guardian

This form is to appoint a guardian for a minor child(ren). The form provided here is simply a sample of what the actual form looks like.

APPOINTMENT OF GUARDIAN

Whereas, _______________________________

and ________________________ are the parents and natural guardians of the following child(ren):

1). _____________________________________ Name

_____________________________________ Age

_____________________________________ Date of Birth

2). _____________________________________ Name

_____________________________________ Age

_____________________________________ Date of Birth

3). _____________________________________ Name

_____________________________________ Age

_____________________________________ Date of Birth

I appoint _____________________________________ (Name and Address) to act as guardian of the minor child(ren) stated above upon my inability to so act.

Should _______________________ be unable or unwilling to serve,

I appoint _____________________________________ (Name and Address) to act as the guardian of the minor children

in the place of ______________________________.

Upon my disability, the designated guardian shall have the following authority:

a) residential custody of the minor child(ren);

b) to approve medical treatment of any kind or type or to disapprove the same within the bounds of the law;

c) to designate schooling for the minor children, and access to any and all of their educational records;

d) to generally act in loco parentis, et.al.

In the event that I am the custodian of any property for the minor children under the Uniform Transfer to Minors Act, or the Uniform Gifts to Minors Act or similar statute, I designate the guardian or successor guardian to act as custodian for all such custodial property.

In the event that formal legal proceedings are commenced to establish a guardian for the child, it is my desire that the guardians mentioned herein have priority in appointment. The failure to list an individual as a guardian or successor guardian is intentional.

___________________________
Signature

___________________________
Date

___________________________
Signature

___________________________
Date

Signature

___________________________
Date

I certify that ______________________________ has appeared before me

on this day of ____________________ (Date).

I am a notary public in the County of ________________________

in the State of ______________________.


My commission expires on _____________________


______________________________
Notary Public

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